Introduction to new updated PIG

New updated GSF Proactive identification guidance (PIG) provides boost for end of life care

March 31st Wolverhampton Press Release

Care for people nearing the end of life received a major boost today with the publication of new fully updated guidance to help health and social care providers identify patients earlier as they approach the final stage of life.

The National Gold Standards Framework Centre (GSF), launched a new revised version 6 of its identification tool, PIG, which has since its original launch in 2001 helped doctors, nurses and care home staff, both in the UK and internationally, increase identification rates by up to ten times, paving the way for improved care for people at the end of their life. It is co-badged by the Royal College of General Practitioners, and recommended as best practice.

The name of the PIG tool has changed to the new ‘Proactive Identification Guidance’, which was formerly known as the GSF RCGP Prognostic Indicator Guide. This indicates the move towards PIG supporting earlier identification of patients leading to more proactive care and prediction of needs, and away from challenges of specific clinical prognostication that can sometimes hamper this approach. However the essence of the PIG early alerting tool remains the same, but has been fully updated in accordance with current expert opinion.

Professor Keri Thomas OBE, GSF Clinical Director, announced details of the updated PIG and its use in practice at the GSF conference in Wolverhampton today. A new web link on the GSF PIG includes guidance on its use, background to its development and evidence from across the world that it can be useful in many different countries, settings and conditions. For example, published research in Australia and New Zealand shows that use of PIG can help identify over 30% of hospital patients, research from the UK affirms its value with patients with COPD and liver disease, and evidence from Italy describes its use in cardiac patients.

A number of leading figures have already welcomed the new guidance and acknowledged the positive impact PIG has had on end of life care over the past 15 years.

Pete Nightingale, former RCGP Lead for End of Life care and current Macmillan UK GP Advisor said: “PIG is the tool that all GP practices in my area use to help identify people approaching the end of their lives, and has contributed to 61% of deaths now occurring outside hospital in North Lancashire. It has played a genuinely significant role in ensuring people receive the care they want, where they want.”

Professor Lisa Bayliss-Pratt, Director of Nursing & Deputy Director of Education and Quality, said: “The Proactive Identification Guidance will help nurses with the important task of earlier identification of people nearing the end of their life who may need additional supportive care. These patients must receive high quality end of life care and have access to the support they need and deserve.”

The new PIG has taken two years to develop in partnership with a number of leading professional organisations who provided expert clinical guidance, including British Geriatric Society, British Thoracic Society and others.

PIG is an easy to use tool to help professionals more easily and effectively identify those people who are approaching the final months of life. It’s a three-step process, starting with the straightforward question, ‘Would you be surprised if the patient were to die in the next year?’ The second step offers general indicators of decline and increasing needs while the third step suggests specific clinical indicators relating to three trajectories.

Prof Thomas said: “Identification is the absolutely crucial first step towards giving quality proactive, person-centred end of life care. It is much easier to plan people’s care, in line with their wishes, once it has been established that they are approaching the end of life, and it is generally helpful to enable patients and families to make the necessary preparatory steps. However, importantly, use of PIG is only the first step of GSF - the next stage is ensuring we ask patients their needs and wishes and provide care in line with their preferences - this is what GSF Programmes provide, all based early alerting for all relevant patients with good use of PIG.

“The new PIG is designed to help professionals identify those people who may be in their final year of life, known often as ‘Gold Patients’, many of whom may not be easy to recognise and on varying trajectories of illness. PIG is an indispensable tool for professionals in hospitals, general practice and care homes enabling doctors and nurses recognise people with across a range of conditions, thereby laying the foundations for good care helping them to live well, and when the time comes, to die well, where they would choose.”

Evidence from eight GSF accredited Acute hospital wards with a range of specialities, shows that they were, on average, identifying 32% of patients. In community hospitals, this figure rose to 59%. An assessment of effectiveness in 17 GSF accredited practices showed that 60% of all patients that died had been identified and were on their end of life care register.

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